Download Trochanter Stabilization Plate for DHS. Extends DHS construct to

Trochanter Stabilization Plate for
DHS. Extends DHS construct to help
stabilize greater trochanter.
Technique Guide
Table of Contents
Introduction
Surgical Technique
Product Information
Trochanter Stabilization Plate for DHS
2
Indications
2
Surgical Technique
Optional Additional Fixation
4
8
Implant Removal
11
Set List
12
Image intensifier control
Trochanter Stabilization Plate for DHS
Technique Guide
Synthes
Trochanter Stabilization Plate for DHS.
Extends DHS construct to help stabilize greater trochanter.
The Trochanter Stabilization Plates extend the DHS construct
to help stabilize the greater trochanter and facilitate insertion
of an antirotation screw into the femoral head.
The combination of the DHS and the Trochanter Stabilization
Plate prevents lateral displacement of greater trochanter
fragments during impaction of the fracture zone. This
helps prevent medialization of the shaft relative to the
head-neck fragment.
Indications
Trochanter Stabilization Plates are used
with Synthes DHS Plates (four holes
or longer) for the following stable and
unstable fractures of the proximal femur:
– Intertrochanteric
– Subtrochanteric
– Pertrochanteric
– Basilar neck
Preoperative
2
Synthes
Trochanter Stabilization Plate for DHS
Technique Guide
Postoperative
Spoon extension minimizes lateral
displacement of greater trochanteric
fracture fragment(s)
Holes for fixation of greater trochanteric
fracture fragments with 4.0 mm Cancellous
Bone Screws
Holes for tension band fixation using
K-wires, cable, or cerclage wire (2.0 mm
or less), or for reattachment of the
gluteus medius with sutures
Large screw hole for parallel placement of
an antirotation screw in the femoral head
Oval hole allows the DHS Lag Screw to glide
through the DHS Plate barrel unimpaired
Recessed screw holes for fixation of the
Trochanter Stabilization Plate/DHS Plate
construct to the femoral shaft, using standard
4.5 mm Cortex Screws
Round hole allows secure placement
of the DHS Plate before the addition of
the Trochanter Stabilization Plate
281.869
281.870
Concave U-shape snaps over the Synthes DHS Plate
Lengths of 138 mm and 148 mm
The DHS Parallel Drill Guide (338.750) allows precise
insertion of a screw superior and parallel to the DHS
Lag Screw at a distance of 12 mm, 17 mm, or 22 mm.
Trochanter Stabilization Plate for DHS
Technique Guide
Synthes
3
Surgical Technique
1
Secure DHS plate
Important: To insert a trochanter stabilization plate and
an antirotation screw parallel and superior to the DHS lag
screw, drill the hole for the lag screw more inferior than
normal. This allows room for placement of the antirotation
screw superior to the DHS lag screw.
Secure the DHS plate to the femoral shaft with one screw
only, through the second-most-proximal DCP hole.
4
Synthes
Trochanter Stabilization Plate for DHS
Technique Guide
Inferior insertion point
Standard
insertion point
2
Contour spoon-shaped end
Instrument
329.02*
Bending Iron, for 4.5 mm plates
329.30*
Plate-Bending Press
391.85
Flat-Nosed Parallel Pliers
Contour the spoon-shaped end of the trochanter stabilization
plate to fit the bone, if necessary. The flat-nosed parallel pliers,
and the bending iron for 4.5 mm plates, or the plate-bending
press may be used to contour the plate.
* Also available
Trochanter Stabilization Plate for DHS
Technique Guide
Synthes
5
Surgical Technique
3
Position plate
Position the trochanter stabilization plate over the DHS plate.
Ensure that the trochanter stabilization plate is securely seated
and that the oval hole allows clearance for the lag screw.
4
Secure plate
Instruments
310.31
3.2 mm Drill Bit
312.46
4.5 mm / 3.2 mm Double Drill Sleeve
Secure the trochanter stabilization plate / DHS plate construct
in position through the remaining screw holes. Drill using the
3.2 mm drill bit with the 4.5 mm / 3.2 mm double drill sleeve.
Measure the depth of the screw holes and insert the screws
according to standard technique.
6
Synthes
Trochanter Stabilization Plate for DHS
Technique Guide
5
Place DHS/DCS compression screw (optional)
If desired, place a DHS / DCS compression screw using
standard DHS technique.
Trochanter Stabilization Plate for DHS
Technique Guide
Synthes
7
Surgical Technique
Optional Additional Fixation
Optional fixation methods through the spoon-shaped
end of the trochanter stabilization plate include:
– 4.0 mm cancellous bone screws
– Cerclage wire
– Orthopaedic cable
– Suture (not shown)
Individual trochanteric fracture fragments may be fixed using
4.0 mm cancellous bone screws through the large holes. A
tension band may be constructed using cerclage wire or cable
through the small holes. The gluteus medius may be reattached
by passing sutures through the small holes.
Fixation with 4.0 mm cancellous bone screws through the large holes
Fixation with cerclage wire through the small holes
Fixation with orthopaedic cable
8
Synthes
Trochanter Stabilization Plate for DHS
Technique Guide
Optional insertion of an antirotation screw using the
DHS parallel drill guide
An antirotation screw may be inserted superior and parallel
to the DHS lag screw. Use one of the following:
– 6.5 mm cancellous bone screw
– 7.0 mm cannulated screw
– 7.3 mm cannulated screw
1
Remove DHS / DCS compression screw, if necessary
2
Reinsert 2.5 mm guide wire through DHS lag screw
3
Slide DHS parallel drill guide
Instruments
338.740
6.0 mm / 4.5 mm Drill Sleeve
338.750
DHS Parallel Drill Guide
Slide the DHS parallel drill guide over the guide wire through
the hole marked “0.” Insert the 6.0 mm / 4.5 mm drill sleeve
into the guide hole marked “12.”
Trochanter Stabilization Plate for DHS
Technique Guide
Synthes
9
Surgical Technique
Optional Additional Fixation
4
Insert appropriate sleeve as indicated below
Antirotation Screw Type
Instrument
7.0 mm Cannulated Screw
4.5 mm / 2.0 mm Insert Wire Sleeve (388.720*)
6.5 mm Cannulated Bone Screw
4.5 mm / 3.2 mm Insert Drill Sleeve (388.730)
7.3 mm Cannulated Screw
4.5 mm / 2.8 mm Insert Wire Sleeve (388.731*)
5
Measure and place
The antirotation screw should be measured and placed
according to the appropriate technique.
* Also available
10
Synthes
Trochanter Stabilization Plate for DHS
Technique Guide
Implant Removal
Remove the implants in the following sequence:
1
All fixation elements (screws, wire, cable, suture)
attached to the spoon-shaped end of the trochanter
stabilization plate (if used)
2
Antirotation screw (if used)
3
Compression screw (if used)
4
DHS trochanter stabilization plate
5
DHS plate
6
DHS lag screw
Please refer to the DHS/DCS Technique Guide and / or the
One-Step DHS/DCS Technique Chart for additional information.
Trochanter Stabilization Plate for DHS
Technique Guide
Synthes
11
Trochanter Stabilization Plate Instrument and Implant Set (105.385)
Graphic Case
690.328
Trochanter Stabilization Plate Instrument
and Implant Set
Instruments
338.730
4.5 mm / 3.2 mm Insert Drill Sleeve
338.740
6.0 mm / 4.5 mm Drill Sleeve
338.750
DHS Parallel Drill Guide
Implants
Trochanter Stabilization Plate, 2 ea.
281.869 ◊
138 mm
281.870
148 mm
◊
◊ Available nonsterile and sterile-packed. Add “S” to produuct number for
sterile product.
Note: For additional information, please refer to package insert.
For detailed cleaning and sterilization instructions, please refer to
http://us.synthes.com / Medical+Community / Cleaning+and+Sterilization.htm
or to the below listed inserts, which will be included in the shipping container:
– Processing Synthes Reusable Medical Devices — Instruments, Instrument Trays
and Graphic Cases — DJ1305
– Processing Non-sterile Synthes Implants — DJ1304
12
Synthes
Trochanter Stabilization Plate for DHS
Technique Guide
Also Available
329.02
Bending Iron, for 4.5 mm plates
329.30
Plate-Bending Press
338.720
4.5 mm / 2.0 mm Insert Wire Sleeve
338.731
4.5 mm / 2.8 mm Insert Wire Sleeve
391.85
Flat Nosed Parallel Pliers
690.344
DHS One-Step Implant Set Graphic Case
690.348
DHS / DCS One-Step Basic Set Graphic Case
Implantation of the Trochanter Stabilization Plate
requires one instrument set and one implant set from
the following:
105.831
DHS / DCS Basic Set, with self-tapping screws
105.833
DHS / DCS One-Step Basic Set, with selftapping screws
105.837
DHS Basic Set, with self-tapping screws
105.35
DHS Universal Implant Set
105.352
DHS One-Step Implant Set
105.839
screws
DHS One-Step Basic Set, with self-tapping
One or more of the following may be required for
optional additional fixation:
105.180
105.07
6.5 mm Cannulated Screw Instrument
and Implant Set
7.0 mm Cannulated Screw Instrument
and Implant Set
105.185
7.3 mm Cannulated Screw Instrument
and Implant Set
105.190
6.5 mm / 7.3 mm Combined Cannulated
Screw Instrument and Implant Set
105.924
Orthopaedic Cable System Instrument Set
105.118
Basic Screw Set, with self-tapping screws
105.408
Small Fragment Instrument and Implant Set,
with self-tapping screws
105.445
Small Fragment Instrument and Implant Set,
with self-tapping screws – LC-DCP
105.92
Wire Instrument and Implant Set
298.801.01S 1.7 mm Cable with Crimp, 750 mm, sterile
Recommended power equipment
105.954
Small Battery Drive
Trochanter Stabilization Plate for DHS
Technique Guide
Synthes
13
Synthes (USA)
1302 Wrights Lane East
West Chester, PA 19380
Telephone: (610) 719-5000
To order: (800) 523-0322
Fax: (610) 251-9056
© 2000 Synthes, Inc. or its affiliates. All rights reserved.
Synthes (Canada) Ltd.
2566 Meadowpine Boulevard
Mississauga, Ontario L5N 6P9
Telephone: (905) 567-0440
To order: (800) 668-1119
Fax: (905) 567-3185
DHS, DCS, DCP, LC-DCP and Synthes are trademarks of Synthes, Inc. or its affiliates.
www.synthes.com
Printed in U.S.A. 1/11 J3349-G